ArticleGlobal health action2021
Forty years after Alma-Ata: primary health-care preparedness for chronic diseases in Mozambique, Nepal and Peru.
Article in Global health action, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06989502 (GH Project), which is not on this map. Cited by 16 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
GH Project: NIHR150261 - Implementation of the COmmunity HEalth System InnovatiON Project, COHESION-I
Who cites it
16 citing papers in PubMed.
- How and by whom are multiple language-related issues managed in transnational qualitative research using content analysis? A scoping review.International journal of nursing studies advances · 2026Article
- A HEARTS-based integrated model for noncommunicable disease control in primary health care in Peru.Lancet regional health. Americas · 2026Review
- Challenges and suffering of people with advanced illness in rural Nepal: a mixed method multiple case study in four municipalities.BMC palliative care · 2026Article
- The landscape of dementia research, diagnosis, treatment, and care in Latin America.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2026Review
- 'I don't think they involve me in any way': Qualitative study of patient centrality in chronic non-communicable disease management in Ghana.BMJ public health · 2026Article
- Exploring factors affecting access to non-communicable disease medicines in low- and middle-income countries: a systematic review.BMJ public health · 2026Article
- Implementation of the community health system innovation project in three low- and middle-income countries: COHESION-I study protocol.BMJ open · 2025Article
- Maximizing researcher-policymaker engagement in global public health.Nature medicine · 2025Review
- Characterising acute and chronic care needs: insights from the Global Burden of Disease Study 2019.Nature communications · 2025Article
- Assessment of Health System Readiness and Quality of Dementia Services in Peru: Protocol for a Qualitative Study With Stakeholder Interviews and Documentation Review.JMIR research protocols · 2025Article
- Access to hypertension services and health-seeking experiences in rural Coastal Kenya: A qualitative study.PLOS global public health · 2025Article
- Health system barriers to hypertension care in Peru: Rapid assessment to inform organizational-level change.PLOS global public health · 2024Article
- A review of neurological health disparities in Peru.Frontiers in public health · 2023Review
- Changes in prevalence and the cascade of care for type 2 diabetes over ten years (2005-2015): results of two nationally representative surveys in Mozambique.BMC public health · 2022Observational
- Rural-Urban Differences in Diabetes Care and Control in 42 Low- and Middle-Income Countries: A Cross-sectional Study of Nationally Representative Individual-Level Data.Diabetes care · 2022Article
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundFour decades after the Alma-Ata Declaration, strengthening primary health care (PHC) remains a priority for health systems, especially in low- and middle-income countries (LMICs). Given the prominence of chronic diseases as a global health issue, PHC must include a wide range of components in order to provide adequate care.
objectiveTo assess PHC preparedness to provide chronic care in Mozambique, Nepal and Peru, we used, as 'tracer conditions', diabetes, hypertension and a country-specific neglected tropical disease with chronic sequelae in each country.
methodsBy implementing a health system assessment, we collected quantitative and qualitative data from primary and secondary sources, including interviews of key informants at three health-system levels (macro, meso and micro). The World Health Organization's health-system building blocks provided the basis for content analysis.
resultsIn total, we conducted 227 interviews. Our findings show that the ambitious policies targeting specific diseases lack the support of technical, administrative and financial resources. Data collection systems do not allow the monitoring of individual patients or provide the health system with the information it requires. Patients receive limited disease-specific information. Clinical guidelines and training are either non-existent or not adapted to local contexts. Availability of medicines and diagnostic tests at the PHC level is an issue. Although medicines available through the public health care system are affordable, some essential medicines suffer shortages or are not available to PHC providers. This need, along with a lack of clear referral procedures and available transportation, generates financial issues for individuals and affects access to health care.
conclusionPHC in these LMICs is not well prepared to provide adequate care for chronic diseases. Improving PHC to attain universal health coverage requires strengthening the identified weaknesses across health-system building blocks.
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